Plantar Heel Pain

Excerpt

As a common problem among adults, plantar heel pain can lead to significant disability and impairment of activities of daily living. Plantar heel pain can be due to local causes, which include plantar fasciitis, referred causes like S1 radiculopathy or systemic illnesses, such as seronegative spondyloarthropathies. The most common causes of plantar heel pain are plantar fasciitis, heel fat pad atrophy, calcaneal stress fracture, or entrapment of the tibial nerve, medial calcaneal nerve, or the first branch of the lateral plantar nerve (Baxter nerve). History taking and physical examination are crucial for correct diagnosis. Laboratory studies can help diagnose systemic causes of plantar heel pain. Plain radiographs and computed tomography can confirm the diagnosis of the stress fractures of the calcaneus and bone tumors. High-resolution ultrasound confirms the diagnosis of plantar fasciitis, heel fat pad atrophy, or entrapment neuropathies. Electrophysiological studies are required to investigate neurogenic causes of plantar heel pain. Magnetic resonance imaging can also help diagnose soft tissue pathologies and may be better than ultrasound for investigating bony disorders. Treatments include lifestyle modification, non-steroidal anti-inflammatory drugs, rehabilitation, local injection, and surgery.